Low Back Pain - Acute;

In the absence of red flags (wt loss, Hx Cancer, fever, Hx infections/surgeries, neuro deficets - especially motor, GI or GU), most back pain is self limiting (under 2 weeks of symptoms) and requires little more than anti-inflamatories, anti-spasmodics (Benzo's, Soma, Flexeril) and gentle return to function.

Some people may benefit from PT, Chiropractors, Osteopathic Manipulation, accupuncture, cupping, etc (basically whatever has worked before - or they think may work that isn't invasive)

Imaging (xrays, CT or MRI) in the absence of red flags are rarely helpful, and may be "abnormal" in up to 50% of asymptomatic patients (high false (+) rate), and lead patients towards surgery - which is increasingly been found to be less than helpful in the 5 year prognosis plan. (ref below)

See the MAP for another way to look at the material.

MM - Sx - LBP 8.2 as Word.doc

Chronic LBP:

Again, review for red flags, and include, chronic pain review (below), addiction potential, (DIRE Score) and a depression screen (below).
The MAP (above) may still apply for acute on top of chronic "flares" though the differential should be broadened

Many patients - particularly those over 40 may have real pain from DJD and benefit from Narcotic/NSAID combos,
but this is usually 2-6 Norco/T#3 day - not dilaudid, percocet or other strong combinations.

Spine Clinic Referral

More Corsets - Less Opiates

Al Loosli's PBL highlights Evidence (references below) that Surgeries, Epidurals, MRI's and Opioids are overused,
(and in many instances are causing more harm than good.) and simple mechanical supports underused
Dr. Loosli recommends: The Bird & Cronen corset "very sturdy with 4 metal stays & works well"
Available from Ortho Tech in Martinez (3rd floor) and the Pittsburg Ortho Techs
(or with a prescription from Kelley & Associates Lennon Ln. Walnut Ceek (925) 256-9999)
see his Handout on exercises for Back Pain